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Q1. I am confused about the effects of sugar alcohols. How do I figure them into my daily sugar intake?

— Penny, Ohio

Sugar alcohols (polyols) are carbohydrates that occur naturally in many fruits and vegetables. They are also made by food manufacturers from starches, glucose, and sucrose, and are commonly added to foods. Corn syrup is most commonly used to make polyols.

Sugar alcohols have a couple of properties that make them attractive for people who would like to reduce their carbohydrate intake but still enjoy sweets. Here are a few things to remember: First, polyols are slowly and not completely absorbed from the gut. This reduces the quantity of carbohydrates the body absorbs and converts into glucose in the bloodstream. Second, most polyols have fewer calories than table sugar.

These substances have been used extensively by food manufacturers to make sugar-free and reduced-carb products. Their texture and feel can help make artificial sweeteners palatable, and they're often used as bulking agents. They are found in sugar-free candies, chewing gum, desserts, baked goods, chocolates, and ice cream. They're also found in some over-the-counter medications, including throat lozenges, cough syrup, and chewable vitamins.

Many diabetics, in their efforts to reduce their carbohydrate consumption or lose weight, have turned to reduced-sugar, sugar-free, or low-carb food products. Although polyols can raise after-meal sugar levels, they raise them less than does table sugar.

To determine the amount of carbohydrates in polyols, you should look at a food's nutrition label. The label will have a carbohydrate section under which the number of grams of polyols are listed. Reduce that number by 50 percent — divide by 2 — to arrive at the total amount of carbohydrate you will absorb. For example, if 10 grams of polyols are listed for one serving of a food, you will absorb about 5 grams. You should also consider the total number of calories in low-carb foods.

Ultimately, here's what you should remember: You don't need to completely eliminate natural sugar, including sugar alcohols, from your diet. Any kind of sugar should, however, be eaten in moderation and with consideration given for the total number of calories you're consuming.

The long-term effect of polyols on people with diabetes is as yet unknown. They might be safe, but limiting them is prudent. And a word about low-carb diets that include polyols: These diets have not been shown to help diabetics lose weight, because the total number of calories in low-carb diets is high.

There are some common changes that can be observed in your sugar levels during your menstrual cycle. (Keep in mind that these changes will not be the same for all women.) Following are some changes that can affect the two phases of the menstrual cycle: the follicular phase, which starts the first day of menses and ends when ovulation occurs (around day 14), and the luteal phase, which begins after ovulation occurs and continues until the first day of menses.

Some women have high levels of glucose during the luteal phase and some have no significant change in either phase, while others see their glucose levels peak in both phases. The cause of this variation is not clear. There is no evidence that hormonal fluctuations (which regulate the menstrual cycle) directly cause high sugar levels. Keep in mind, however, that many women experience cravings for high-carbohydrate foods during the late luteal phase of their cycle. It is possible that your eating patterns change in the week before your menstrual cycle and affect your glucose levels. Keeping a food diary will help you evaluate if this is the reason for your premenstrual rise in glucose levels.

Q3. Is it dangerous to be pregnant with type 2 diabetes?

— Sally, California

Many potential complications of diabetes and pregnancy can be averted or managed with good care from a qualified health-care professional. Women with type 2 diabetes should consult with their doctors before becoming pregnant to determine their individual risk for complications and begin preconception care. Optimal glucose control before pregnancy with a combination of medicine, a healthy diet, and exercise is a prerequisite, as well as folic acid supplementation and other usual preconception and prenatal measures. Since the safety of many oral diabetes medicines to the fetus is not known, women should begin insulin treatment. Glucose control during pregnancy is difficult due to hormonal changes, so it's also important to monitor your blood sugar closely and maintain normal levels. Finally, because obesity also makes sugar control difficult, overweight or obese women with diabetes should try to lose weight before becoming pregnant.

However, pregnancy in women with diabetes does carry a much greater risk than in non-diabetic women. Both mom and baby can develop complications, and some of these complications are life-threatening. Stillbirths are twice as common, and deaths during the first month and within a year are more than three times as common in infants born to mothers with type 2 diabetes. These babies also have more than 10 times the risk of congenital malformation and are often large for their gestational age, which puts them at a greater risk for developing diabetes later on in their lives. The mothers have greater odds of developing hypertension and toxemia of pregnancy and hemorrhaging after delivery. Some of these complications in both mom and baby occur more frequently if the mother's sugar levels are not controlled or if she has diabetes-related kidney disease (diabetic nephropathy) or coronary artery disease. Another complication of diabetes, gastroparesis, causes sluggish absorption of nutrients from the mother’s gut, limiting their availability to both mom and the growing fetus.